Chapter One: The Evolution and Seduction of Pseudoscience

In 2018, millions of subscribers to Goop—Gwyneth Paltrow’s $250 million natural lifestyle company—were introduced to a new promoted product: the $135 Implant O-Rama, a do-it-yourself coffee enema device. The product’s website claimed that coffee enemas “can mean relief from depression, confusion, general nervous tension, many allergy related symptoms, and most importantly, relief from severe pain.” The company told its consumers: “Ask not what your colon can do for you, but rather, what you can do for your colon.” Coffee enemas were even endorsed on Goop by seemingly respectable physicians: namely, a cardiologist, Alejandro Junger, identified as an “adrenal fatigue expert,” and “holistic psychiatrist” Kelly Brogan in her New York Times bestseller, A Mind of Your Own: The Truth About Depression and How Women Can Heal Their Bodies to Reclaim Their Lives.

What’s the problem? Well, it turns out that shooting coffee up your bum will not help with depression or any other health concern. Coffee enemas have a long history in the alternative medicine community despite their lack of credible evidence. They were first introduced as a part of the Gerson Therapy, which was developed by a physician, Max Gerson, in the 1930s for the treatment of degenerative diseases, including cancer. Modern proponents of the therapy still claim that coffee enemas work by helping with liver and in­testinal detoxification. The scientific reality is that there is no medical theory or body of research supporting the use of coffee enemas, and in fact they can be quite dangerous and result in burns, inflammation, bacteria in the blood­stream, and even death.

Goop subscribers who purchased Kelly Brogan’s book about depression were introduced to even more products, services, and “natural treatments for whole- body wellness” beyond coffee enemas. They were told in Brogan’s book that a laundry list of supplements was critical to their health and that “un­less you are growing your own organic food in a bubble hermetically sealed from the ravages of the modern industrial world, strategic supplementation is almost always going to help you get better and stay better.” They were recommended to doubt whether the scientific construct of depression was even real and were warned about the purported dangers of antidepressant medication, Advil, Lipitor, Prilosec, fluoride, fragrances, genetically mod­ified foods (GMOs), antibiotics, vaccines, and birth control pills. In short, they were sold a cornucopia of misinformation.

There exists little evidence to support the vast majority of Brogan’s claims. For example, in the American Psychological Association’s official clin­ical practice guidelines for the treatment of depression—which were de­veloped by health professionals from psychology, psychiatry, and primary care, as well as community members who self-identified as having had depression—it’s recommended that depression be treated with evidence-based psychotherapies and antidepressants. After reviewing the science, the guidelines don’t recommend anything resembling Brogan’s unnecessary and expensive testing and supplementing or dietary plan. And of course, there’s no mention of coffee enemas.

* * *

I’m a full-time practicing clinical psychologist, adjunct assistant professor in the Department of Psychology at the University of Calgary, researcher, and science communicator, and during the last several years I’ve cultivated social media in my quest to call out the questionable practices of grifters, such as those peddled by Goop and Kelly Brogan. A brief definition of grifters: A grifter is a swindler. A charlatan. A fake. A snake oil salesman like Clark Stanley, who sold “snake oil liniment” in the late 19th and early 20th centuries as a cure-all for various health conditions— incidentally, it didn’t work, and it didn’t even contain actual snake oil. A grifter is a person that preys upon the financial and emotional vulnerabilities and health of people to make a profit. Money aside, their motivations can be manifold. Self-deception is certainly one of them, as many even buy into their own pseudo-profound bullshit (believe it or not, that’s actually a science term). At the end of the day, regardless of their intentions—even if they believe they’re doing the right thing—grifters worsen health outcomes. They sell fake cures, pseu­doscience, and false hope—and that’s a real problem for anyone needing as­sistance with mental health or illness.

* * *

Imagine that you’re a patient who is experiencing depressive symptoms and other mental health concerns. You feel tired all the time, unmotivated, anxious, and empty. Your appetite is low. You don’t know what’s wrong; you just know that you’re in psychic pain. You want help. You figure that the first step is to get a diagnosis. Your friend tells you that they stumbled upon a great “integrative medicine” clinic on the internet when searching for a massage therapist. The website says that they have a psychologist and a naturopath and that they believe in a “holistic” approach that treats the whole person and the “root cause” rather than “masking the symptoms.” You think that sounds reasonable. So you book an appointment. You meet with the psychologist. They are inviting and friendly and use fancy psy­chological terms when explaining how they can help you. So you go for it and agree to the assessment. You aren’t familiar with the tests, but they say they’re using a Myers-Briggs Type Indicator (MBTI) and a Rorschach inkblot. You think you might remember those names from movies you’ve seen but aren’t quite sure. They conduct a 2-hour interview with you and ask you about your upbringing. You then see the naturopath, who also asks you about your childhood, as well as your diet. Together, they diagnose you with “adrenal fatigue.” They offer you “energy medicine”—specifically, Reiki—to help “balance your energies.” And they sell you some homeo­pathic remedies to help with your tiredness and low appetite. You don’t know it just yet—and they might not know it either—but you’ve just been conned. Adrenal fatigue is a fake diagnosis. It doesn’t exist as a recognized medical condition. And both energy medicine and homeopathy are un­equivocally pseudoscience: We would literally have to violate the laws of physics for them to work.

As a clinical psychologist, I have encountered many patients who received pseudoscientific assessments and treatments for their addiction and mental health concerns. The tidal wave of pseudoscientific mental health practices originates both within and outside of the mental health professions. The global health and wellness industry has an estimated value of over $5.6 trillion, which includes legitimate sources of health—such as club memberships and exercise classes—as well as alternative medicine products and services that purport to improve health, based on baseless or exaggerated claims and ques­tionable evidence of safety and effectiveness. In the world of mental health care, scientists have estimated that there are at least 600 “brands” of psycho­therapy, an unreasonably and quickly growing number. Beyond that world exist countless unregulated providers of mental health–related services in the wellness industry and alternative medicine community who market them­selves as “life coaches,” “wellness consultants,” and— depending on particular countries and jurisdictions—other various non–legally protected titles, such as “therapists,” “psychotherapists,” “counselors,” and “practitioners.”

Snake oil salesmen, then, in the spirit of Clark Stanley, never went away. The debate about what constitutes pseudoscience is as old as science itself. At least as old as Aristotle, the philosophy of science as a discipline of study rose to the fore in the 19th and 20th centuries, as scientists made tremendous advances in fields as diverse as genetics, geology, physics, and health. It was during this time that many individuals, groups, and theories were accused of being pseudoscientific, such as astrology, creationism, and believers in the paranormal.

Historically, the world of mental health has had its own accusations of pseudoscience, notably in the cases of phrenology, an attempt to un­derstand mental life by linking personality traits with skull shape, and Sigmund Freud’s psychoanalysis, an attempt to treat mental illness based on Freud’s theories of the mind. While phrenology perished in the sands of time, psychoanalysis survived by eventually morphing into a modern evidence-based treatment approach called psychodynamic therapy. In the late 16th and early 17th centuries, Franz Anton Mesmer gained many followers by “mesmerizing” and claiming to heal by aligning magnetic forces, a practice that was a precursor to modern hypnosis. The field of psychiatry fared no better with its claims of treating mental illness with spinning chairs, bloodletting, leeching, prefrontal lobotomies, casket-like Utica cribs, hot and cold baths, purging, blistering, dental removal, mer­cury dosing, and many other treatments, which are now recognized as useless or harmful.

Pseudoscience is a nebulous term. In short, it is a hijacked and failed attempt at science. But that definition doesn’t quite capture its complexity. The first thing to understand about differentiating science from pseudosci­ence is that there is no single, clear criterion that tells one from the other. Nor is there a single person who can make that call. This problem—of trying to figure out whether a particular discipline, treatment, assessment tool, or research program falls under the purview of pseudoscience—is known in science as the “demarcation problem.” In other words, where do we demarcate, or draw the line between, science and pseudoscience? While philosophers of science have been wrestling with the demarcation problem for centuries, I find it useful to understand pseudoscience as best identified by a cluster of warning signs, such that science differs from pseudoscience in degree rather than in kind. I’ll introduce you to these warning signs in Chapter 5.

Scott O. Lilienfeld was a modern giant in the field of clinical psychological science and devoted much of his career to elucidating and exposing pseudo­scientific practices in the field of psychology. He and his colleagues offered a metaphor for anyone stumped by the demarcation problem. They compared the distinction between science and pseudoscience to the boundary between day and night: The fact that the precise boundary is unclear does not imply that the two cannot be meaningfully differentiated.

No one grows up dreaming of becoming a pseudoscientist, and no one wants to be labeled one either. The truth is that the label itself matters much less than the reasons why something might be considered pseudoscien­tific. Instances of unequivocal pseudoscience serve as a distorted mirror warning against what not to do scientifically. In other cases, that gray zone in which we’re left to decide whether pseudoscience has reared its decep­tive head is supposed to be muddy—but it gives us cause to pause, and to proceed with caution when critically thinking about claims related to mental health.